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To report on a case of autoconjunctival graft compromise after pterygium surgery in a patient on long-term anti-vascular endothelial growth factor (anti-VEGF) therapy, due to the deleterious effects of anti-VEGF agents on ocular wound healing. A white female in her early eighties presented with large right nasal pterygium, first noted 5 years previously. She also had macular degeneration and had been receiving monthly injections of ranibizumab, which was later switched to aflibercept. She proceeded to have a right nasal pterygium excision with a conjunctival autograft, 9 days after her last dose of intravitreal aflibercept. Surgery was uneventful; however, at the week 2 postoperative review, there was conjunctival graft dehiscence with melting of the graft and underlying sclera. The patient was administered hyperbaric oxygen treatments, topical antibiotics, steroids, and lubricating eye drops, and aflibercept injections ceased. The scleral melt slowly resolved and her aflibercept was restarted 3 months later. This case highlights the potential hazards of performing elective surgery in patients on VEGF inhibitors and the need for an appropriate interval between cessation/subsequent restart of anti-VEGF agents and surgery to be established.

To report a novel intervention for the treatment of conjunctival lymphangiectasia-subconjunctival injection of bevacizumab.A 53-year-old white male presented with a 3-month history of right ocular discomfort and redness unresponsive to conventional topical treatment of lubricants and steroids. A clinical diagnosis of conjunctival lymphangiectasia was confirmed by biopsy. Bevacizumab (25 mg/mL) was injected subconjunctivally into the affected area.An improvement in the degree of conjunctival chemosis was evident at 5 days postinjection. At 1-month follow-up, symptoms had fully resolved. No recurrence had been observed at 3 years' follow-up.Subconjunctival bevacizumab injection may be an effective treatment for conjunctival lymphangiectasia.

Dry eye is prevalent in many parts of the world. As a result, ophthalmologists and other health care professionals, such as optometrists and general practitioners, often help these patients manage their symptoms. The most common form of treatment for management of dry eye is over-the-counter tear lubricants. A number of tear lubricant formulations are available that vary by their mechanism of action. This article suggests simple guidelines on how lubricants can be selected for patients with mild to moderate dry eye. Side effects of lubricants, such as burning on instillation because of mismatches of eye drop with tear acidity, are also discussed.

To study the range of ocular manifestations in an Australian cohort of patients with pemphigus and bullous pemphigoid (BP), including a detailed assessment for dry eye syndrome (DES).Twenty-two patients with pemphigus vulgaris, pemphigus foliaceus, and BP were referred for a detailed ophthalmology review between September 2011 and March 2012.A total of 44 eyes of 22 patients with pemphigus vulgaris, pemphigus foliaceus, and BP were examined. Photophobia was the most common symptom reported. The most common ocular signs found in both groups were blepharitis (68.1%), conjunctival hyperemia (22.7%), and limbal broadening (18.2%). In our DES assessment, 92.9% of patients had a reduced Schirmer test score and an abnormal tear break-up time was recorded in 100% of patients. The ocular surface disease index score ranged from 0 to 47.2, with a median score of 10.The high occurrence of patient-reported ocular symptoms and clinical evidence of dry eye on Schirmer testing and break-up time demonstrate high prevalence of DES in our cohort of pemphigus and BP patients, which is a novel finding. Limbal broadening was another common finding not previously reported.